Provider Demographics
NPI:1215339338
Name:SAVAGE, JENA (PA-C)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-1211
Mailing Address - Country:US
Mailing Address - Phone:928-668-6165
Mailing Address - Fax:
Practice Address - Street 1:38 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1211
Practice Address - Country:US
Practice Address - Phone:928-668-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant